AR Caller / AR Follow-Up (RCM) – Senior Executive

Employment Type: Full-Time
Work Mode: Work from Office
Location: Sector 18, Gurugram

We are seeking a highly skilled Senior Executive – AR Follow-Up & Denial Management to join our Revenue Cycle Management (RCM) team. The ideal candidate will possess strong experience in Accounts Receivable (AR) follow-up, claims resolution, and denial management within the US Healthcare domain.

This role requires expertise in handling denial types such as Authorization Issues, Duplicate Claims, Bundled Services, Inclusive Denials, Coordination of Benefits (COB), Timely Filing, Medical Necessity, Non-Covered Services, and other payer-related denials. The successful candidate will work closely with insurance payers, healthcare providers, and patients to ensure maximum reimbursement while maintaining strict HIPAA compliance.

• Conduct AR follow-up activities to resolve unpaid, underpaid, and denied claims.
• Investigate and address denial reasons, including No Authorization, Duplicate, Bundled, Inclusive, COB, Medical Necessity, Timely Filing, and other payer-specific denials.
• Communicate with insurance companies to obtain claim status updates, determine denial causes, and facilitate resolution.
• Review and validate patient demographics, insurance information, and registration details.
• Coordinate with clients to resolve coding, billing, or documentation-related discrepancies.
• Submit claims electronically and via paper formats while ensuring complete accuracy.
• Monitor outstanding claims and follow up within designated billing cycle timelines.
• Prepare and submit appeals for denied or rejected claims with supporting documentation.
• Perform insurance eligibility and benefits verification through online portals and payer calls.
• Review patient billing records for completeness and accuracy, resolving missing or incorrect information.
• Process ERA (Electronic Remittance Advice) and EOB (Explanation of Benefits) postings.
• Apply knowledge of payer guidelines, including Medicare, Medicaid, Commercial Plans, HMO, and PPO policies.
• Maintain detailed documentation of all account activities and follow-up actions.
• Ensure adherence to HIPAA regulations and organizational quality standards.

• Minimum 2 years of experience in US Healthcare AR Follow-Up and Denial Management.
• Strong understanding of denial categories such as Authorization, COB, Duplicate, Bundled, Inclusive, and other payer-specific denials.
• Knowledge of insurance payer regulations, appeals processes, and coordination of benefits.
• Hands-on experience with charge entry, claims submission, and payment posting (ERA/EOB).
• Ability to interpret medical billing records, superbills, and claims documentation.
• Excellent verbal and written communication skills.
• Strong analytical, organizational, and problem-solving abilities.
• Ability to manage multiple priorities while meeting productivity and quality targets.
• Familiarity with credentialing processes is an added advantage.
• Experience handling Protected Health Information (PHI) in compliance with HIPAA requirements.

• Join a dynamic and fast-growing healthcare RCM team.
• Competitive salary package with performance-based incentives.
• Opportunities for continuous learning and career advancement.
• Collaborative work environment that supports professional development.
• Stable and rewarding career path in the US Healthcare industry.